Good communication with your children helps everyone in the family cope with whatever changes lie ahead.

Among the many difficult questions parents face when diagnosed with cancer is, “What do I tell my children?” Fearful that they might upset or worry their youngsters and teens, some parents withhold the news. But even at a very young age, children can sense when something is wrong. If not told the truth, they might imagine that things are worse than they really are, or even that they themselves are the cause of the problem.

Talking to a child about a parent’s, grandparent’s, or sibling’s cancer and how it will affect the family isn’t easy, but it is necessary. This booklet can help. It includes tips for talking with children about a family member’s cancer and treatment. It also suggests ways to help children cope with some of the feelings they may experience at this time.

By talking with your children honestly and helping them express their emotions, you make it easier for them to feel safe and secure. And as their parent, you are the best judge of how to talk to your children. But the first conversation about cancer is often the hardest. The information in this booklet will help you start that conversation and give you the tools to keep it going every step of the way.

Talking About the Diagnosis

It’s usually best to talk with your children soon after the diagnosis is known. Sharing information early on will help build trust. When children know they are being kept informed, it helps make the experience less frightening. This is not to say that talking about cancer is easy. Here are some tips for talking to your children about your diagnosis:

Prepare what you want to say. Many parents find it helpful to practice or write down what they want to say before the first conversation. Other parents feel that having their spouse, partner, close friend, or a relative with them makes it easier. Parents also tell us that choosing a quiet time when they and their children are rested makes the conversation less stressful.

Speak with your older children first. If you have children of different ages, the older children may want to help you tell your younger children. Try to have these conversations as close together as possible so that all members of the family are aware of the situation and have a chance to support each other.

Set the tone. As important as what you say is how you say it. Try using a calm, reassuring voice. It’s okay if you become sad or feel like crying. Some adults and children who think of crying as a sign of weakness will bottle their feelings inside, causing more distress. When a parent expresses sadness through crying, it is showing children that it is okay to do the same. If your children become upset or wander off, tell them that you know this is a tough conversation and you understand how they feel. You can always come back to it later.

Keep it brief. Remember that children, especially young ones, tend to have short attention spans. Do not talk longer than they can listen, but be sure to ask them if they have questions.

Be honest. If you don’t know the answer, let your children know you will find out and get back to them as soon as possible. This teaches them that although parents don’t always have all the answers, they will do their best to help their children. This also lets children know that they have permission to ask any questions they like.

Consider your child’s age. When speaking with your children, use age-appropriate language. By using words that are common and familiar, your children will have an easier time understanding your cancer and what to expect.

Reassure your children. No matter what their age, it’s important to let your children know that what they are feeling is normal and okay. Finding out what they might have heard about cancer is also helpful so you and the health care team can clear up any misinformation. Be honest and hopeful. Having frequent conversations in the days ahead will help your children feel safer and more secure.

Be hopeful. Some children may ask from the beginning if their parent (or family member) affected by cancer is going to die. In most cases it will be enough to say that with the doctor’s help, you’ll be doing everything possible to get rid of the cancer and that you’re hopeful you’ll get better. If your cancer is advanced and aggressive, you can still tell your children that your doctors are doing their best to treat it and that you’ll let them know how the treatment goes.

Contact CancerCare. If you need guidance before talking with your children, or at any time afterward, contact CancerCare. Our team of professional oncology social workers can help you find age-appropriate ways to answer your children’s questions and concerns and can refer you to helpful resources. If your family is dealing with a difficult prognosis, we can help by providing one-on-one counseling and referrals to support services close to where you live.

Talking About the Treatment Plan

Whether you choose to talk about the treatment plan early on or at a later date, the important thing is to keep your children informed. Since treatment is likely to bring about many changes in your family’s day-to-day life, encourage your children to ask questions if they are concerned or confused. Here are some suggestions for talking to children about the treatment plan:

Let children know about any changes to their routines. When talking about a parent’s treatment, many children want to know what it will mean for them. If Mom is in the hospital, who will take them to school, make dinner, or take them to after-school activities? Let your children know these concerns are important to you, too. If you don’t have your support team (relatives, neighbors, and friends) in place yet, reassure your children that there will be a plan and that you’ll let them know about it.

Prepare children for possible side effects of treatment. In discussing your treatment with children, you will want to prepare them for possible side effects. Seeing side effects from chemotherapy, such as a parent’s hair loss, weight loss, or nausea, can be upsetting to children. If children understand in advance that the side effects are part of the treatment and not part of the illness, they can handle things better. With children ages 5 to 8 you might use crayons and paper to make simple drawings of some of the changes that might occur, such as hair loss. This will give your child a more concrete way to understand that there will be changes with the treatment.

Give simple, reassuring explanations. For most children, you do not need to go into a lot of detail about side effects. For example, you might tell a child age 5 to 8, “Mom has to take very strong medicine to get rid of the cancer. It might make her lose her hair and feel sick, but it will be from the strong medicine, not the cancer.” Or if radiation is involved: “Mom is going to have a treatment that might make her very tired. When she gets home, she will need a lot of rest,” or, “Mom may not be able to play with you as often as I want, but I do love you very much.” Because different people respond differently to treatment plans, let your children know if you’re not sure what side effects you might have. But reassure them that you or another important person in their life (parent, close relative, family friend) will help them prepare for any changes. Providing this kind of comfort and support shows your continued love and caring for your children during a difficult time.

Help children stay connected to you during your treatment. One way to help your children cope with your cancer is to help them feel connected to you while you’re in treatment. For example, if you’re going to be in the hospital, your children might draw pictures for your room or send cards. If you’re able, you might want to make a drawing or send a note home to them as well. Letting your children know how much you love them and that you’re thinking of them will make it easier for them to cope while you’re in the hospital.

Stay connected at home, too. It might be difficult to do some of the things you were able to do before. For example, cancer and cancer treatment may prevent you from lifting or carrying your toddler or young child. Your child may miss this and want to be close. By hugging each other from a seated position or lying down with your child on the floor, couch, or bed, he or she can be at eye level with you and feel comforted in your arms. Unstructured activities, such as watching TV with your children or talking about their day at school, can also bring a sense of togetherness.

Allow your child to participate in your care. You may find that your child wants to help but doesn’t know what to do. Giving children simple tasks, such as bringing you a glass of water or an extra blanket, helps them feel connected. Teenagers can take on larger tasks around the house, such as washing dishes or mowing the lawn. But they shouldn’t be expected to handle adult responsibilities, such as paying bills.

Let your children know that it’s okay be kids. Tell your children that you are thankful if they want to help, but that you don’t expect them to take care of you all the time. That is not their job. Their job includes things like going to school, doing their homework, seeing friends, playing sports, and having fun. Children should not feel guilty about being children. Let your children know that although you (or another family member) has cancer, it is not all that your family is about. Remind them often that no matter what changes the cancer might bring, your love for them will never change.

Keeping the Lines of Communication Open

Learning that someone in the family has cancer is an emotional experience for children. They might feel afraid, confused, guilty, or angry. In fact, they are likely to feel different things at different times. If you help your children stay informed and connected, they will have an easier time coping with the changes that cancer brings. Let them know that strong feelings are normal, and encourage them to speak freely and openly. Here are some tips to keep communication flowing:

Let your children know they can always come to you and that you will tell them the truth. Be honest and hopeful.

If your children have trouble talking about cancer, suggest that they try writing down their questions and concerns. Your medical team and CancerCare can help you find answers for anything you’re unsure about.

Use games or arts and crafts projects. Children are more likely to identify and communicate their feelings through play. They will tell you how they feel just by drawing a picture of something that’s on their minds.

Schedule family update meetings when children can discuss what’s on their mind, share how they are feeling, and find out new information.

Build a support network. Speak with your spouse or partner, close friends, or your child’s teachers and guidance counselors at school about being available should your child need additional support. Make sure your child feels comfortable with this.

Try to spend relaxed, stress-free time with your children to talk about their hobbies, school life, friends, and activities. Help your children feel free to talk about fun things. Let them know that cancer is only one of many things to talk about. Enjoy being together.

Don’t be afraid to ask for help. CancerCare provides free counseling, education, and practical help for families coping with cancer. All our services are free of charge.

Frequently Asked Questions

Q. Ever since I told my son about my cancer, he has been acting out at school and wanting to stay home. What can I do?

A. Chances are your child is very worried about your cancer and may want to stay home to make sure you’re okay. Perhaps he thinks you need him to help out. Reassure your child that it’s okay to feel angry and upset, but that while you work hard to get rid of the cancer, you need him to work hard at school and to keep up with his homework, his friends, and his activities. Give him lots of praise for his efforts, and try to spend some relaxed, unstructured time together after homework. Children need to know that their parents are in charge. The routine of school and consistency of everyday activities help children feel safe and secure.

Be sure to speak with your child’s teacher or principal to explain the changes in your household. Your school district is likely to have trained professionals who can help your child deal with the difficulties he is having. In addition, the professional oncology social workers at CancerCare can be called upon for help and advice.

Q. I am currently in remission, but my daughter wants to know if the cancer will come back. What should I tell her?

A. Remission is certainly great news. Let your child know how happy you are to be in remission and that you are looking forward to enjoying time with your family. If your daughter is concerned that the cancer will come back, you should tell her there is no sign of the cancer now and that you are optimistic that things will stay that way. Let her know that you and your doctor will be doing everything possible so that you stay cancer-free. If there’s any chance of a recurrence, tell her you will let the family know so you can deal with it together.

Q. What if I get upset or start to cry when talking to my children about the cancer?

A. Speaking with your children about your cancer, even if you write down or practice what you are going to say, is bound to be difficult. At the start of your conversation, tell your children that you might get sad or upset during your talk. In this way, they will be prepared for your emotions. If you feel you are going to cry and have difficulty continuing, stop a moment and take a few slow, deep breaths. It does not hurt children to see that their parent is sad or cries. If your children comfort you, for example, by giving you a hug, it is important to praise them. Knowing that your child has developed empathy is never a bad thing, no matter what the circumstances. When you feel more calm, begin again. This will show your children that even when people have strong feelings, they can manage. You will learn from each other how important it is to keep talking and supporting one another. The important thing is to stay connected.

Q. What if my treatment makes me feel too sick to take care of my children?

A. If possible, it’s best to have a plan in place before your treatment begins. Since there is no way to predict with certainty how your particular treatment will affect you, it’s good to make sure you have plenty of support. Your spouse or partner may be busy with work, helping you get to your doctor, and taking care of you, so you may need to call on others for awhile. One way is to ask someone your child knows well, such as a family member or close friend or relative, to act as a “coordinator.” When other friends or neighbors ask what they can do, this person can put things in motion. For example, someone might help with meals, another person might help getting your children to school, and another might help with grocery shopping or other chores. If you put a schedule together of your children’s activities, your coordinator can help your children keep as normal a routine as possible. If your children are invited for sleep-overs and outings, it will give you time to rest. Friends, relatives, and neighbors know that when they help out, they are giving you time to concentrate on getting better. Don’t be afraid to ask. If you need additional help with daily tasks, CancerCare can refer you to a variety of services in your area and can help with emotional, practical, and financial concerns.

Q. My teenagers want to meet my doctors and see the hospital. Is this a good idea? Are there support groups for teens?

A. It is not unusual for teenagers to express an interest in learning as much as possible about their parent’s cancer, including meeting the doctors and seeing the treatment facility. This is a good idea. You might ask your doctor to set aside time to meet with your teens so they can ask questions and your doctor can suggest resources or appropriate websites for reliable information. When you allow your teens to demonstrate their ability to handle things in a mature way, you show them that you have confidence in them. Let your teens know how proud you are of them and stay in touch with their feelings. Support groups for teens, such as those available through CancerCare, also make it easier for teens to feel informed and connected.